Friday, April 8, 2016

Multicultural Psychology Post on Health (care) Disparities

This was a discussion board post for my Multicultural Psychology class. The topic was culture and health, and the chapter focused pretty heavily on health disparities and health care disparities. We're supposed to write at least 600 words and cite at least 5 research sources outside the textbook per discussion, though I usually (as here) will be making at least one of those citations in my responses to other students. (So, uh, professor? If you do a plagiarism check, yes I am the math TA in your class. Congratulations on finding my blog.)

Chapter 8 discussed culture and health.
Part of the chapter is on health (care) disparities. Health
disparities are the different rates of being healthy or sick (or
having specific conditions) between groups, while health care
disparities are the differences in treatment and in access to
treatment (Mio, Barker, & Tumambing 2012). These two disparities
can not be reasonably separated, as receiving poor care (or no care)
can lead people to try to deal with health problems on their own and
mistrust doctors, which in turn rather definitively leads to not
accessing health care. I know
that past healthcare experiences have influenced my decisions to
(not) seek care for illness or injury. After I had a doctor explain
that my injury (which I had already said
was a month prior) could not be a broken foot because for a broken
foot to appear as it did on the MRI, the injury would need to be
about a month old, my trust definitely decreased. It was, in fact, a
broken foot. I suspect he couldn't believe a person would be able to
walk on a broken foot for a month. Another doctor taking my inability
to assign a number to my pain to mean I wasn't in
pain decreased my trust further. The only pain scale I've ever found
that I could comprehend is based on behavioral cues, and since I'm
fairly sure walking on a broken foot isn't supposed to be 2/10 on any
pain scale, I can't exactly use that scale at the doctor's office.
There are many who believe that autistic people have a reduced
sensitivity to pain or don't feel pain as well, which really doesn't
help when I'm trying to seek treatment for issues where pain is a
symptom. Fitting that particular stereotype only makes getting
medical treatment harder (Allely 2013), and I expect the experience
is similar for other groups who are often assumed to feel less pain.

Mio
et. al. give multiple examples of people of color receiving care
later or receiving less treatment than white people in the chapter,
both in personal stories and in statistics (2012). Racism has
historically played a role in treatment, and knowledge of this racism
plays a role in the decision to seek care or not (Bhopal 1998).
Similar forces are in play for people living in poverty, who may
choose to delay care due to an inability to pay for it or wait until
they are in need of the emergency room because the ER (theoretically)
can not turn them away entirely. Interestingly, decreased utilization
of healthcare by those of lower socioeconomic status holds even
when they have health insurance
(Fiscella, Franks, Gold, & Clancy 2000).

In
terms of the choice to attempt access to health care or not to make
the attempt, historical and current racism play a significant role
for many people of color. Medical and scientific racism, such as that
which was partially involved in eugenics and in experiments like the
Tuskegee syphilis study, led to continuing mistrust of the medical
system. In addition, research on health care disparities has often
framed the problem as lying within cultural choices of the
marginalized group, which does little to create trust (Bhopal 1998).

In connection to these issues, I look
back at the concept of imposed etics: “imposition of an outsider's
worldview on a different culture” (Mio, Barker, & Tumambing
2012, p. 64). There really are differences in (attempted and
successful) health care utilization between marginalized groups and
privileged groups. However, in assuming this is because marginalized
people culturally don't care
about their health or don't believe
that modern medicine can be effective at what it claims it can do,
researchers are imposing their worldview and ideas of what reasons
for action make sense on members of other cultures who have other
worldviews! I know that as an Autistic person, I absolutely care
about my health, including my mental health. I also totally believe
the analysis suggesting that autistic people who are referred to
interventions earlier and who received applied behavioral analysis
are more likely to achieve the “optimal outcome” of losing their
diagnosis (Orinstein et. al. 2014). I just don't care.
No amount of evidence that an intervention can “help” me achieve
a goal I don't have and rather explicitly reject is going to convince
me to pursue that intervention, because it isn't evidence that the
intervention can help me reach goals I do
have. In fact, the imposed etic where outsiders presume my ideal
outcome for mental health care is to stop being autistic, or at least
act less autistic, contributes to my reluctance to pursue any
mental health care. Even therapy meant for issues comparatively
unrelated to autism gets sidetracked by this assumption, and also by
assumptions about what it means to be mentally healthy that may not
apply given that my natural cognitive styles are, by definition, not
standard.